Search

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Complex wounds in the hand and distal lower extremities pose challenges in reconstructive surgery, often involving critical structures like tendons. Tendon injuries, prevalent in such wounds, necessitate optimal repair methods for functional recovery. This study investigates the impact of vascularised and nonvascularised adipofascial tissue on tendon repair, focusing on early healing stages, mobilisation, and scintigraphic evaluation of flap vascularity. Materials and Methods: Wistar Albino rats were divided into groups undergoing primary tendon repair, vascularised adipofascial flap application, or nonvascularised flap application. Scintigraphic evaluation and histopathological assessment were performed to analyse healing processes. Results: Pedicle-free flaps support healing in tendon injuries without negatively affecting medium-term outcomes. Vascularised flaps exhibit faster healing. The scintigraphic analysis showed that the static measurements of the late phase were statistically significantly higher in the group with the non-vascularised adipofascial flap (p = 0.038). The mean perfusion reserve was higher in the vascularised pedicled adipofascial flap group than the non-vascularised adipofascial flap group. Scintigraphic analysis highlights the viability of pedicle-free flaps. Conclusions: Pedicle-free adipofascial flaps support the healing of the tendon without complicating the results, while vascularised flaps show accelerated healing. These findings provide valuable insights into optimising tendon repair strategies using adipofascial flaps, with implications for enhancing functional recovery in complex wounds. [ABSTRACT FROM AUTHOR]

In the setting of trauma, occurrence of intracapsular lipo-hemarthrosis is not uncommon, highly useful and well known imaging finding. Occurrence of extracapsular lipohaemarthrosis is uncommon and have been noticed around the large joints like knee, hip, and shoulder joints. Extracapsular lipohaemarthrosis is rare especially around small joints like wrist joint. A 20-year-old male presented to emergency outpatient department following a fall on an outstretched hand, reported with subsequent pain, swelling, and restricted movement at the wrist joint. Imaging revealed a mildly displaced oblique fracture at the distal end of the radius with extension into the articular surface of the inferior radio-ulnar articulation. Additionally, fat-fluid level was observed around the extensor tendon at the wrist joint level, indicative of extra capsular lipo-hemarthrosis. Presence of fat fluid level around the joint, intra capsular or extra capsular should raise the suspicion of underlying fracture.

The technology of 3D bioprinting has sparked interest in improving tendon repair and regeneration, promoting quality of life. To perform this procedure, surgical intervention is often necessary to restore functional capacity. In this way, 3D bioprinting offers a scaffold design, producing tendons with precise microarchitectures, promoting the growth of new tissues. Furthermore, it may incorporate bioactive compounds that can further stimulate repair. This review elucidates how 3D bioprinting holds promise for tendon repair and regeneration, detailing the steps involved and the various approaches employed. They demonstrate future challenges and perspectives and provide valuable information on the concept, bioprinting design, and 3D bioprinting techniques for the repair of tendon injuries.

Objective Percutaneous repair is an alternative to open surgical repair of the Achilles tendon with comparable, functional results and low re‐rupture and infection rates; however, sural nerve injury is a known complication. The purpose of this study is to design a new surgical procedure, the minimally invasive peritendinous submembrane access technique (MIS‐PSAT). It offers optimal results, with excellent functional outcomes, and with minimal soft tissue complications and sural nerve injury. Methods This retrospective study included 249 patients with acute closed Achilles tendon ruptures treated at our institution between 2009 and 2019. All patients underwent MIS‐PSAT at our institution and were followed up for 8–48 months. Functional evaluation was based on the Achilles tendon total rupture score (ATRS) and the American Orthopedic Foot and Ankle Society Ankle‐Hindfoot Scale (AOFAS‐AHS), associated with local complications and isokinetic tests. Results None of the patients had infection, necrosis, or sural nerve injury. Re‐rupture occurred in two cases. The average times to return to work and sports was 10.4 and 31.6 weeks, respectively. The average ATRS and AOFAS‐AHS scores were 90.2 and 95.7, respectively, with an excellent rate of 99.5%. Isokinetic tests showed that ankle function on the affected side was comparable with that on the healthy side (p > 0.05). Conclusion The MIS‐PSAT for acute Achilles tendon rupture is easy to perform with few complications. Importantly, the surgical technique reduces the risk of sural nerve injuries. Patients have high postoperative satisfaction, low re‐rupture rates, and muscle strength, and endurance can be restored to levels similar to those on the healthy side.

Heterotopic ossification (HO) is a pathological process that commonly arises following severe polytrauma, characterized by the anomalous differentiation of mesenchymal progenitor cells and resulting in the formation of ectopic bone in non-skeletal tissues. This abnormal bone growth contributes to pain and reduced mobility, especially when adjacent to a joint. Our prior observations suggested an essential role of NGF (Nerve Growth Factor)-responsive TrkA (Tropomyosin Receptor Kinase A)-expressing peripheral nerves in regulating abnormal osteochondral differentiation following tendon injury. Here, we utilized a recently developed mouse model of hip arthroplasty-induced HO to further validate the role of peripheral nerve regulation of traumatic HO. Nerve ingrowth was either modulated using a knockin transgenic animals with point mutation in TrkA, or local treatment with an FDA-approved formulation of long acting Bupivacaine which prevents peripheral nerve growth. Results demonstrate exuberant sensory and sympathetic nerve growth within the peri-articular HO site, and that both methods to reduce local innervation significantly reduced heterotopic bone formation. TrkA inhibition led to a 34% reduction in bone volume, while bupivacaine treatment resulted in a 50% decrease. Mechanistically, alterations in TGFβ and FGF signaling activation accompanied both methods of local denervation, and a shift in macrophages from M1 to M2 phenotypes was observed. In sum, these studies reinforce the observations that peripheral nerves play a role in the etiopathogenesis of HO, and that targeting local nerves represents a potential therapeutic approach for disease prevention. [ABSTRACT FROM AUTHOR]

Tendon injury is a common motor system disease, impairing joint mobility, and lowering quality of life. Once damaged, tendon has a limited capacity for regeneration. Clinically, available therapeutic strategies have not achieved satisfactory outcomes. Chiral biomaterials can effectively regulate cell behaviors and tissue healing, but have not been applied to injured tendon yet. Here, chiral arginine is attached to electrospun membrane to fabricate chiral scaffolds. L‐chiral scaffold, rather than D‐chiral or R‐chiral scaffold, promotes cell adhesion, proliferation, and tenogenic differentiation. The vinculin/FAK/YAP pathway is discovered to have a significant impact on the processes mentioned above. Additionally, L‐arginine efficiently eliminates reactive oxygen species (ROS) and generates nitric oxide (NO), safeguarding tendon stem/progenitor cells (TSPCs) against oxidative stress. The use of L‐chiral scaffold in a rat model of Achilles tendon injury increases the expression of markers related to tendons and the deposition of collagen. Moreover, L‐chiral scaffold improves tendon structural, functional, and mechanical properties. This L‐chiral scaffold comprehensively enhances tendon healing, providing a promising therapeutic strategy for tendon injury. As a simple and effective method, modification by chiral molecules enriches biomaterial functions and offers a novel option for tissue regeneration. [ABSTRACT FROM AUTHOR]

Simple Summary: The description of health patterns of eventing horses outside of veterinary clinics is limited. It is important to determine the relative impact of different health problems in this group of horses. The study aimed to describe the prevalence and patterns of lameness/illness in registered British eventing horses in 2018 by use of an online survey. Data were collated and descriptive analyses undertaken. In total, 1677 surveys were completed, and 49.4% reported a previous lameness/musculoskeletal problem, with 26% in the previous six months. The most frequently reported musculoskeletal problems were to the foot (421), joints (382), wounds (340), back (333), ligament (205), tendon (213), bones (140) and muscles (135). The most frequent non-musculoskeletal problems were to the skin (183), gastric ulceration (173), colic (145) and infection (88). Injuries to the sole of the foot/muscles/tendons were most frequently sustained in competition, suspensory ligament/splint bone/stifle/hock injuries were more frequently sustained in training and foot abscesses/penetration injuries at rest. Horses with deep digital flexor tendon injuries were out of training for the most amount of time (>12 months) and horses with hock/sole bruising/foot abscesses for the least amount of time (<2 weeks). A greater understanding of health problems in eventing horses could be useful for veterinarians working with them. There has been little investigation into the health patterns of the eventing horse population outside veterinary clinics. To target health problems in the eventing horse population, it is important to determine the relative impact of different health problems. The objectives were to describe the prevalence and patterns of lameness/illness in registered British eventing horses. An online survey was released for all horses registered with British eventing in 2018. Data were collated and descriptive analyses undertaken. A total of 1677 surveys were completed, among which 49.4% reported a previous lameness/musculoskeletal problem, 26% being in the previous six months. The most frequently reported musculoskeletal problems were in the foot (421), joints (382), wounds (340), back (333), ligament (205), tendon (213), bones (140) and muscles (135). The most frequent non-musculoskeletal problems related to the skin (183), gastric ulceration (173), colic (145) and infection (88). Injuries to the hoof sole/muscles/tendons were most frequently sustained in competition, suspensory ligament/splint bone/stifle/tarsal injuries were more frequently sustained in training and abscess/foot penetration at rest. DDFT injuries were most frequently out of training for >12 months, SDFT/stifle/suspensory ligament for <12 months, tendon sheath/splint bone for <3 months and tarsal/sole bruising/abscess for <2 weeks. A greater understanding of injuries/illnesses frequently sustained could be useful for veterinarians working with event horses. [ABSTRACT FROM AUTHOR]

The technology of 3D bioprinting has sparked interest in improving tendon repair and regeneration, promoting quality of life. To perform this procedure, surgical intervention is often necessary to restore functional capacity. In this way, 3D bioprinting offers a scaffold design, producing tendons with precise microarchitectures, promoting the growth of new tissues. Furthermore, it may incorporate bioactive compounds that can further stimulate repair. This review elucidates how 3D bioprinting holds promise for tendon repair and regeneration, detailing the steps involved and the various approaches employed. They demonstrate future challenges and perspectives and provide valuable information on the concept, bioprinting design, and 3D bioprinting techniques for the repair of tendon injuries. [ABSTRACT FROM AUTHOR]

In the last two decades, ultrasound has been fully implemented in the diagnosis and management of rheumatoid arthritis. Several studies have been published that have demonstrated better availability of this technique in the identification of elementary inflammatory joint and tendon injuries, as joint and tendon sheath synovial hypertrophy, joint effusion, and Power Doppler signal. Ultrasonography has good properties to identify changes with different treatments, have predictive value for relapse in patients in clinical remission and in structural damage. Furthermore, ultrasound tools have been developed that allow prospective evaluation of patients. Joint and tendon ultrasound evaluation indexes have been used for disease diagnosis and monitoring. Initially, indexes have been integrated only for joint, but more recently have appeared mixed indexes, integrated for ultrasound evaluation and other types of variables. There are still important objectives to be achieved to complete the development of ultrasound in rheumatoid arthritis, which makes ultrasound a great aid tool in decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Hamstring strain injuries (HSIs) are prevalent in sports involving high-speed running and most of the HSIs are biceps femoris long head (BFlh) injuries. The primary cause for HSIs during high-speed running remains controversial due to the lack of in vivo measurement of the BFlh muscle behavior during running. Therefore, the purpose of this study was to quantify the muscle-tendon unit (MTU) and fascicle behavior of BFlh during running. Seven college male sprinters (22.14 ± 1.8 years; 177.7 ± 2.5 cm; 70.57 ± 5.1 kg; personal bests in 100m: 11.1 ± 0.2 s) were tested on a motorized treadmill instrumented with two force plate for running at 4, 5, 6m/s. The ground reaction force (GRF), 3D lower limb kinematics, EMG, and ultrasound images of biceps femoris long head (BFlh) in the middle region were recorded simultaneously. BFlh fascicles undergo little length change (about 1 cm) in the late swing phase during running at three submaximal speeds. BFlh fascicle lengthening accounted for about 30% of MTU length change during the late swing phase. BFlh was most active during the late swing and early stance phases, ranging from 83% MVC at a running speed of 4 m/s to 116% MVC at 6 m/s. Muscle fascicles in the middle region of BF1h undergo relatively little lengthening relative to the MTU in the late swing phase during running in comparison to results from simulation studies. These results suggest that there is a decoupling between the fascicle in the middle region and MTU length changes during the late swing phase of running. [ABSTRACT FROM AUTHOR]

Introduction: Flexor tendon injuries are common and require surgery. Acellular dermal matrix (ADM) is a natural graft used to repair tissues, though infections represent the primary cause of its therapeutic failure. In this study, zinc oxide nanoparticles (ZnO-NPs) were coated on the ADM in order to add antibacterial potential as well as enhance healing properties. Also, the produced ADM/ZnO-NPs graft was applied to accelerate fifth zone flexor tendon repair following the reconstructive surgery. Methods: Morphological, mechanical, cell viability, and antibacterial tests were performed to evaluate the physical and biological properties of the fabricated ADM/ZnO-NPs graft. For clinical evaluations, 20 patients with a flexor tendon injury in zone 5 were randomly divided into control and treatment with ADM/ZnO-NPs groups (n=10 each). The control group had routine reconstructive surgery, while the other group received the ADM/ZnO- NPs graft during their surgery. Postoperative functional outcomes were evaluated 4, 6, and 8 weeks following the tendon repair surgery according to the Buck-Gramcko II criteria. Results: The ADM/ZnO-NPs had natural derm specifications as well as dense and integrated morphology with intermediate antibacterial properties. According to the Buck-Gramcko II criteria, the postoperative functional outcome scores were significantly higher in the ADM/ZnONPs group in comparison with the control group at 4 (P<0.01), 6 (P<0.01), and 8 (P<0.001) weeks after the surgery. Conclusion: The present findings revealed that the ADM/ZnO-NPs graft can accelerate the healing of the damaged tendon without common post-operative functional complications and adhesions following the tendon repair surgery. However, more comprehensive clinical trials are still needed. [ABSTRACT FROM AUTHOR]

Biomechanical analysis using cyclic testing for repaired flexor tendons is a clinically relevant method. The aim of this study was to evaluate the tensile properties of two six-strand suture techniques, the triple looped suture and Yoshizu #1 suture techniques using cyclic testing under simulating early active mobilization conditions. Twenty-five flexor digitorum profundus tendons harvested from fresh frozen human cadaver hands were repaired in zone 2 utilizing one of three repair techniques: the 2-strand modified Kessler (MK) technique as a control, the triple looped suture (TLS) and Yoshizu #1 suture (Y1) techniques. In each suture technique, 4-0 monofilament nylon sutures were used for core sutures and 6-0 monofilament nylon sutures for circumferential running sutures. Cyclic testing was performed using 20 N with 600 cycles at 1 Hz. Five out of eight specimens in the MK group ruptured during cyclic testing. Thus, this group was excluded from analysis. On the other hand, all tendons in the TLS and Y1 groups tolerated cyclic testing. Average gaps of the TLS and Y1 groups were 0.5 ± 0.8 mm and 1.9 ± 2.2 mm, respectively. All tendons in the TLS group and six out of nine tendons in the Y1 group formed gaps less than 2 mm. Two tendons in the Y1 group formed a gap of 3.8 and 6.6 mm had breakage of peripheral sutures at the first cycle. Mean ultimate tensile force of the TLS and Y1 group measured after cyclic tensing, were 66.2 ± 9.0 N and 65.9 ± 13.1 N, respectively. No statistical difference between the two groups was found in gap and ultimate tensile forces. This study suggested that the TLS and Y1 techniques have tensile properties to allow early active mobilization. None of tendons repaired with the TLS technique had gaps more than 2 mm. [ABSTRACT FROM AUTHOR]

Gluteus medius tendon pathology, encompassing tendinopathy and tears, is a significant source of lateral hip pain and functional impairment. Traditional diagnostic approaches have relied on clinical examination and magnetic resonance imaging (MRI). However, the advent of diagnostic musculoskeletal ultrasound MSKUS has transformed the evaluation process. Musculoskeletal ultrasound MSKUS has emerged as a highly valuable diagnostic tool in the evaluation of gluteus medius tendon pathology, offering a non-invasive, cost-effective, and dynamic assessment method. This modality provides real-time visualization of soft tissue, enabling the detailed examination of tendon structure, vascularity, and associated musculature. For rehabilitation providers, understanding the application, strengths, and limitations of diagnostic MSKUS can enhance clinical decision-making, facilitate targeted therapeutic interventions, and potentially expedite the recovery process. This article reviews the application of MSKUS in diagnosing gluteus medius tendon pathology and its implications for rehabilitation practice. This should help to equip rehabilitation professionals with knowledge to better integrate this diagnostic tool into their clinical repertoire. [ABSTRACT FROM AUTHOR]

Background Clinical assessment of triceps brachii tendon tears is challenging, and conventional imaging methods have limitations. Timely surgical referral is important in high-grade tears to maximize patient outcomes, and musculoskeletal ultrasound (MSK US) can be used at the time of clinical examination to identify such injuries requiring advanced imaging and orthopedic referral. Hypothesis/Purpose The purpose of this case report is to describe how MSK US was used to facilitate advanced imaging and timely orthopedic referral for a patient presenting to a physical therapist with a high-grade triceps tendon avulsion. Study Design Case Report Case Description A 35-year-old male soldier presented to a direct access sports physical therapist with acute-on-chronic right elbow pain. Physical examination and MSK US were used to identify a high-grade partial triceps brachii tendon tear. The MSK US findings informed the physical therapist's decision-making process to refer the subject for timely advanced imaging studies as well as referral to an orthopedic physician. Outcomes A high-grade partial triceps tendon avulsion was confirmed on magnetic resonance imaging (MRI). The subject was then seen by an orthopedic surgeon and underwent surgical repair of the tendon within the recommended three-week timeframe for optimal outcomes. The subject completed a post-operative rehabilitation program and returned to full physical and occupational activities. Conclusion MSK US can assist in the diagnosis of challenging triceps tendon injuries, facilitating timely advanced imaging and orthopedic referrals for high-grade injuries to optimize patient outcomes. Level of Evidence 5 [ABSTRACT FROM AUTHOR]

A 68-year-old man on hemodialysis treatment for end-stage kidney disease secondary to autosomal dominant polycystic kidney disease (ADPKD) complained of right ankle pain that impaired walking ability two weeks after the initiation of intravenous levofloxacin as a treatment for concomitant liver cyst infection. A systemic workup led us to conclude that our patient had a fluoroquinolone-associated tendon injury. Such a disease condition has been recognized as a serious adverse event resulting from the receipt of fluoroquinolones in various clinical settings. Fluoroquinolones have received focus as standard therapeutic agents for liver and/or renal cyst infection because of their lipophilic properties that lead to good penetration into infected cysts. However, reports on fluoroquinolone-associated tendinopathy in patients with ADPKD associated with cyst infection are sparse. We believe the current report illustrates the pitfalls associated with managing patients with ADPKD who are subjected to the administration of fluoroquinolones due to infectious complications. [ABSTRACT FROM AUTHOR]

Flexor tendon injuries cause serious work and health losses. Studies on flexor tendon injuries have generally focused on treatment modalities. The study's goal is to retrospectively screen the cases admitted to a single center and reveal in detail the causes of injury and the patients' sociodemographic characteristics. The study included 120 patients who applied to our center between January 2015 and December 2017 with a flexor tendon injury and underwent surgery on the same day. We investigated the patients' age, gender, and hand dominance as demographic characteristics. We classified the injury characteristics as the mechanism of the injury, the nature of the injury, the identity and number of affected fingers, the injured area and side, the number of involved tendons, the accompanying fractures, the nerve injury, and the vascular injury. As surgical details, we evaluated the type of anesthesia and the duration of the surgery. We identified 171 flexor tendons and 120 patients, of which 85% (n=102) were male and 15% (n=18) were female. Home accidents caused 26.6% of the injuries (32/120). Most patients had a single finger injury (88/120, 73.3%). Injuries were most common in Zone 2 (61/171, 35.6%). Patients with vascular and nerve injuries, along with flexor tendon injuries, were in the majority (48%). Our study provides detailed sociodemographic information about flexor tendon injuries. Because this study sheds light on injury mechanisms, it will serve as a guide for preventing such injuries. [ABSTRACT FROM AUTHOR]

The article discusses the challenges in understanding the extensor tendon system in the hand and the discrepancies in the descriptions of extensor zones in different sources. The author conducted a study and proposes a new classification based on the presence of the extensor retinaculum, suggesting that the future definition of Zone 7 should be clearly stated as the area covered by the extensor retinaculum, without referring to the wrist joint. The author also presents an alternative method of zone division for the extensors, which corresponds to the number of flexor zones and may simplify treatment discussions. However, the author acknowledges the potential confusion that may arise from introducing a new classification. [Extracted from the article]

Various techniques have been developed to optimize the repair of zone II flexor tendon injuries. The aim of the present study was to compare the biomechanical outcomes of four different methods: resection of the single flexor digitorum superficialis (FDS) slip; A2 pulley venting; and two different A2 pulley plasty methods. In total, 36 cadaveric fingers were dissected to determine the gliding coefficients (GC), maximum flexion angles (MFA) and bowstring measurements through digital imaging before and after surgical procedures. The GC increased significantly (p < 0.05) and MFA decreased significantly (p < 0.001) in all groups after the surgical interventions. There were no statistically significant differences between the surgical techniques regarding GC (p = 0.756) and MFA (p = 0.089). Bowstring distance significantly increased in the pulley venting group (p < 0.001). The pulley plasty results were comparable to the other techniques. The single FDS slip resection technique should be considered as the method of choice for reducing the GC following flexor tendon repair as it preserves the anatomical structure of the A2 pulley. Level of evidence: V [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the frequency and timing of platelet-rich plasma (PRP) injection in tendon healing. We aimed to evaluate the effectiveness of single versus multiple PRP injections in the healing of patellar tendon defects in the experimental model, through histological and biomechanical investigation. Methods: Forty-four male skeletally mature Dutch rabbits were randomly divided into the five study groups (A, B,C, D,E). After creating a longitudinal acute patellar tendon defect on both knees (One-third the width of the patella tendon), the right legs of the rabbits were used as the intervention group and the left legs as the control groups. Animals in groups A, B, and C were euthanized on days 7, 14, and 28, respectively, after the first PRP injection. Animals in group D received the second PRP injection on day 10 and was euthanized on day 14. Animals in group D received the second and third PRP injections on days 10 and 20, respectively, and were euthanized on day 28. The outcomes were evaluated histologically (modification of Movin's Grading) and biomechanically. Results: The inflammatory condition was exaggerated in groups D and E. Load at failure was higher in the non-injected side of groups D and E, while there was no significant difference between the right and left legs of the three groups A, B and C. In other word, groups with a single PRP injection were more resistant to the increasing load compared to the groups with multiple PRP injections. Conclusions: PRP improves tendon healing if injected early after injury, while its injection after the initial phase of injury hampers tendon healing. In addition, a single PRP injection seems to be more effective than multiple PRP injection. Therefore, in cases where PRP injection is indicated for tendon repair, such as acute tendon injury, we recommend using a single PRP injection during tendon repair surgery. [ABSTRACT FROM AUTHOR]

Tendons are one of the major load-bearing tissues in the body; subjected to enormous peak stresses, and thus vulnerable to injury. Cellular responses to tendon injury are complex, involving inflammatory and repair components, with the latter employing both resident and recruited exogenous cell populations. Gene expression analyses are valuable tools for investigating tendon injury, allowing assessment of repair processes and pathological responses such as fibrosis, and permitting evaluation of therapeutic pharmacological interventions. Quantitative polymerase chain reaction (qPCR) is a commonly used approach for such studies, but data obtained by this method must be normalised to reference genes: genes known to be stably expressed between the experimental conditions investigated. Establishing suitable tendon injury reference genes is thus essential. Accordingly we investigated mRNA expression stability in a rat model of tendon injury, comparing both injured and uninjured tendons, and the effects of rapamycin treatment, at 1 and 3 weeks post injury. We used 11 candidate genes (18S, ACTB, AP3D1, B2M, CSNK2A2, GAPDH, HPRT1, PAK1IP1, RPL13a, SDHA, UBC) and assessed stability via four complementary algorithms (Bestkeeper, deltaCt, geNorm, Normfinder). Our results suggests that ACTB, CSNK2A2, HPRT1 and PAK1IP1 are all stably expressed in tendon, regardless of injury or drug treatment: any three of these would serve as universally suitable reference gene panel for normalizing qPCR expression data in the rat tendon injury model. We also reveal 18S, UBC, GAPDH, and SDHA as consistently poor scoring candidates (with the latter two exhibiting rapamycin- and injury-associated changes, respectively): these genes should be avoided. [ABSTRACT FROM AUTHOR]

Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5–3 months and 4–6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes. [ABSTRACT FROM AUTHOR]

Background: The aim was to assess the diagnostic accuracy of DECT in diagnosing Achilles tendon tears, using MRI as the reference for diagnosis. Methods: This feasibility study conducted prospectively at a single center included consecutive patients suffering from ankle pain who underwent DECT and MRI between April 2023 and October 2023. A total of three radiologists, blinded to the patient's clinical data, assessed the images. Achille Tendon injuries were diagnosed in case of thickened and inflamed tendons or in case of a partial or complete tear. Diagnostic accuracy values of DECT were calculated using a multi-reader approach. Inter-observer agreement was calculated using k statistics. Results: The final study population included 22 patients (mean age 48.5 years). At MRI, Achille's tendon lesion was present in 12 cases (54.5%) with 2 cases of complete rupture, 8 cases of partial tear (5 with tendon retraction), and 2 cases of tendon thickening. The mean thickness of injured tendons was 10 mm. At DECT, R1 was allowed to correctly classify 20/22 cases (90.9%), R2 19/22 cases (86.4%), and R3 18/22 cases (81.8%). At DECT, the mean thickness of the positively scored tendon was 10 mm for R1, 10.2 mm for R2, and 9.8 mm for R3. A very good agreement was achieved with regard to the evaluation of tears (k = 0.94), thickness (k = 0.96), and inflammatory changes (k = 0.82). Overall agreement was very good (k = 0.88). Conclusions: DECT showed a good diagnostic performance in identifying Achille's tendon tears, with respect to MRI. [ABSTRACT FROM AUTHOR]

Patellar tendinopathy is more prevalent in males versus female athletes and commonly presents in the medial region of the tendon. Separate measures of patellar tendon strain in the medial, central, and lateral regions of the tendon, however, have not been quantified. The purpose was to investigate the differences in tendon strain between the medial, lateral, and central regions of the patellar tendon in healthy men and women. Strain in the medial and lateral regions of the patellar tendon in healthy participants (10 males, 10 females) was evaluated using ultrasound during isometric quadriceps contractions at 20%, 40%, 60%, 80%, and 100% of maximum voluntary contraction (MVIC) in 60° and 90° of knee flexion. Central strain was also measured at 60% MVIC in 90° of knee flexion. Mixed models were used to determine strain between tendon regions and sex at 60% MVIC in 90° of knee flexion. Sequential modeling was used to fit region, sex, %MVIC, and angle to predict strain. The central region had less strain compared with both medial and lateral regions. The lateral region had higher strain compared with the medial region regardless of sex. Females had higher strain compared with males, regardless of region. Knee position did not influence tendon strain. Patellar tendon strain differs by region and sex. The varying prevalence between sex and in location of patellar tendinopathy may in part be explained by the unbalanced strains. Differential assessment of regional patellar tendon strain may be of importance for understanding injury risk and recovery with exercise. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown that injury to the popliteus tendon has little consequence for the static stability of the knee following total knee arthroplasty (TKA). However, very few studies have evaluated the effect of intraoperative iatrogenic popliteus tendon injury on the patient-reported outcome measures (PROMs) following TKA. This study aimed to determine the incidence of iatrogenic popliteus tendon injury in our subset of the population and to find out its effect on PROMs. Methods: 100 consecutive osteoarthritic varus knees with flexion deformities less than 20° were operated upon by a single senior experienced arthroplasty surgeon. Patients were assessed intraoperatively for any iatrogenic popliteus tendon injury, the injury site, and the amount of injury which was quantified and graded. PROMs applied for assessment at 1-year follow-up were Knee Society Score (KSS 1), Knee Function Score (KSS 2), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results: 17% of cases had an iatrogenic popliteus tendon injury. Thirteen had grade II injuries, whereas four had grade III injuries. There was no statistical significance in post-operative knee mobility and PROMs among those with popliteus tendon injury versus non-injured patients. Conclusion: The incidence of iatrogenic popliteus tendon injury is higher than what we expected. The tendon injury remains a risk, but it is unclear how the popliteus tendon injury will affect patients after the TKA. In our series, such an injury during knee replacement does not affect the functioning of the knee in the short term; however, a long-term follow-up is warranted. [ABSTRACT FROM AUTHOR]

Pediatric wrist injuries pose unique diagnostic challenges due to distinct bone characteristics in children and their diverse injury patterns. The dynamic development of the wrist, marked by changes in bone age and emerging ossification centers, is crucial to evaluate growth and identify potential pathologies. The skeletal composition, rich in cartilage, renders bones relatively weaker yet more elastic, impacting their susceptibility to fracture. Forearm fractures display diverse patterns influenced by torsional forces. Scaphoid fractures, less common in children, differ from those in adults. Conditions like Madelung's deformity and ulnar variance are more common wrist disorders in the pediatric population. In addition, the scarcity and nonspecificity of symptoms in those with tendon injuries and triangular fibrocartilage complex lesions can be diagnostically challenging. This article reviews pediatric wrist injuries, emphasizing ossification patterns, common fracture types, and developmental variants. Grasping these complexities in pediatric wrist development and associated pathologies is essential for precise diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Distal nerve transfers can restore precise motor control in tetraplegic patients. When nerve transfers are not successful, tendon transfers may be used for subsequent reconstruction. In this case, an extensor carpi radialis brevis (ECRB) tendon transfer was used to restore thumb and finger flexion following an unsuccessful ECRB to anterior interosseous nerve transfer in a young tetraplegic patient. Twelve months following tendon transfer, the patient demonstrated functional grip and pinch strength and was using both hands for daily activities. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Finger flexor pulley injuries are the most common overuse injuries sustained by climbers. These injuries are caused by forceful gripping techniques specific to climbing, making them uncommon in non-climbing activities. With the growing popularity of climbing, there is a rising need for accurate diagnosis and improved treatment methods. This paper explores current diagnostic techniques, including physical examination, ultrasound, and magnetic resonance imaging. It also discusses treatment options, which range from conservative rehabilitation to surgery, depending on the severity of the injury. Finally, it emphasizes the importance of injury prevention through proper warm-up and avoiding excessive strain. [ABSTRACT FROM AUTHOR]

Background: Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. Purpose: To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Study design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies–of Interventions and risk-of-bias tool for randomized trials tools. Results: A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P =.01) and mean peak load (433.9 N vs 212 N; P =.042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Conclusion: Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes. [ABSTRACT FROM AUTHOR]

We encountered the aberrant muscle called transverse carpal muscle (TCM) anterior to the transverse carpal ligament (TCL) during endoscopic carpal tunnel release (ECTR) for a 56-year-old female with left carpal tunnel syndrome (CTS). Our ECTR technique started with making the distal portal and the anomalous muscle emerged in the portal. We changed ECTR to open carpal tunnel release to clarify the anatomy around TCL to avoid iatrogenic tendon and neurovascular injuries. The TCM does not necessarily exist bilaterally, and our case has also it unilaterally, because the TCM was not observed during the ECTR on the opposite side. Distal incision first ECTR technique enabled us to find the TCM which we could not encounter if conventional ECTR was performed. [ABSTRACT FROM AUTHOR]

Background: Fluoroquinolones (FQs) are associated with increased risk of tendon injury but comparative risk versus other antibiotic options for the same indication has yet to be evaluated. Objective: Describe the incidence (relative risk) of any tendon injury in patients receiving FQ compared with other (non-FQs) antibiotics for treatment of community-acquired pneumonia (CAP). Methods: A retrospective propensity score weighted cohort study was performed to evaluate the association between FQ antibiotics and tendon injury risk at 2 time points (within 1 month and within 6 months of use) compared with non-FQ regimens for treatment of CAP. The evaluation was performed using the CCAE (MarketScan Commercial Claims and Encounters) and COB (Medicare Supplemental and Coordination of Benefits) databases from 2014 to 2020. Patients with ICD (International Classification of Diseases) 9/10 coding for outpatient pneumonia who were >18 years and without history of tendon injury were included. Patients with history of tendon injury, who received multiple antibiotic therapies for recurrent pneumonia, or who received both FQ and non-FQ regimens during the study period were excluded. Propensity score weighting was used to adjust for selection bias due to contributing risk factors, including demographics (age, sex), comorbidities (diabetes mellitus, chronic kidney disease), and concurrent medications (corticosteroids). Results: At 1 month, the odds of tendon injury were estimated to be significantly higher (41.9%) in patients receiving FQs compared with those receiving a non-FQ-based regimen (odds ratio [OR] = 1.419, 95% confidence interval [CI] = [1.188-1.698]). The odds of tendon injury were also estimated to be higher (OR = 1.067, 95% CI = [0.975-1.173]) in the FQ population within 180 days, but this effect was not statistically significant. The most frequent sites of tendon injuries were rotator cuff, shoulder, and patellar tendon. Conclusions and Relevance: Prescribers should recognize the risk of tendon injury within 1 month of FQ use when considering treatment regimens for CAP and use alternative options with lower risk whenever possible. [ABSTRACT FROM AUTHOR]

Due to their potential positive outcomes, hamstring eccentric exercises are becoming increasingly popular in training regimens. Among the various exercises, the Nordic Hamstring Exercise (NHE) is the most common. Despite its popularity, there are still some doubts about its benefits and risks. So, the aim of this umbrella review was to summarize the effects of NHE on performance and injury prevention. Following the PRISMA guidelines, a comprehensive literature search was conducted across multiple e-databases, according to the P (injured and non-injured athletes or recreationally active or healthy individuals) I (NHE) C (no intervention, placebo, or other interventions) O (performance or injury) S (systematic reviews) model. The quality of the studies was accessed with the AMSTAR-2. From the 916 systematic reviews found, only 10 could be included. They encompassed 125 studies, enrolling 17,260 subjects. The results from the studies indicate that NHE interventions demonstrated positive effects on sprint performance, muscle activation, eccentric strength, and muscle architecture (fascicle length, muscle thickness, and pennation angle). Furthermore, NHE is effective in preventing hamstring injuries (up to 51%). In conclusion, NHE should be integrated in training (especially, in the warm-up phase) for both enhancing athletic performance and preventing hamstring injuries. For achieving more positive results, it is recommended that high-volume is followed by low-volume maintenance, targeting 48 reps/week. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO), the pathological formation of bone within soft tissues such as tendon and muscle, is a notable complication resulting from severe injury. While soft tissue injury is necessary for HO development, the specific molecular pathology responsible for trauma‐induced HO remains a mystery. The previous study detected abnormal autophagy function in the early stages of tendon HO. Nevertheless, it remains to be determined whether autophagy governs the process of HO generation. Here, trauma‐induced tendon HO model is used to investigate the relationship between autophagy and tendon calcification. In the early stages of tenotomy, it is observed that autophagic flux is significantly impaired and that blocking autophagic flux promoted the development of more rampant calcification. Moreover, Gt(ROSA)26sor transgenic mouse model experiments disclosed lysosomal acid dysfunction as chief reason behind impaired autophagic flux. Stimulating V‐ATPase activity reinstated both lysosomal acid functioning and autophagic flux, thereby reversing tendon HO. This present study demonstrates that autophagy‐lysosomal dysfunction triggers HO in the stages of tendon injury, with potential therapeutic targeting implications for HO. [ABSTRACT FROM AUTHOR]

Tendon injuries, often leading to debilitating adhesions, pose significant challenges in clinical practice. Conventional treatments have limitations, necessitating novel strategies. Injectable hydrogels, known for their biocompatibility, have shown promise. To enhance their antiadhesive properties, researchers have started incorporating drugs. Existing drug delivery systems often peak in the initial days, falling short during the fibroblast proliferation phase which occurs ≈1 week after injury. In this research, CI1040 is selected as an antiadhesion drug, encapsulated within zeolitic imidazolate framework‐8(ZIF‐8), and incorporated into oxidized hyaluronic acid/N‐carboxyethyl chitosan(OHA/CEC) hydrogel(Gel), resulting in the synthesis of CI1040@ZIF@Gel. This unique pH‐responsive drug release system involves encapsulating CI1040 within ZIF‐8, a substance that degrades under acidic conditions while remaining stable in physiological environments. This system selectively releases the drug during the fibroblast proliferation phase, responding to the localized pH reduction post‐tendon injury. CI1040@ZIF@Gel exerted a 65% inhibition on extracellular signal‐regulated kinase (ERK) phosphorylation, reducing the production of collagen types III (Col III) in the adhesion area by 56%. These results indicate that CI1040@ZIF@Gel can effectively inhibit fibroblast proliferation and adhesion through the interleukin 9 receptor/mitogen‐activated protein kinase/extracellular signal‐regulated kinase(IL9r/MEK/ERK) pathway, while also acting as a physical barrier to prevent the formation of tendon adhesion. [ABSTRACT FROM AUTHOR]

Tendon injuries and tendinopathies are increasingly prevalent health problems currently lacking effective treatments. Tissue engineering offers promising strategies to boost the low innate regenerative ability of tendons. Within this context, the simultaneous leveraging of both physical and biochemical cues by engineered scaffolding systems can be explored to promote a stronger tenogenic response from stem cells. Here, molecularly imprinted polymeric nanoparticles (MINPs) against transforming growth factor (TGF)‐β3 are combined with bioinspired anisotropic hydrogels to produce tenogenesis‐inductive constructs. MINPs are first solid phase‐imprinted against a TGF‐β3 epitope, achieving an affinity comparable to monoclonal antibodies. MINPs and magnetically‐responsive microfibers are then encapsulated together with adipose‐derived stem cells within gelatin‐based hydrogels, applying a magnetostatic field during gelation to align the microfibers. The created anisotropic microstructure guides cell growth and elongation unidirectionally, while MINPs act as artificial receptors for TGF‐β3, potentiating its paracrine action in the cellular microenvironment. The combination of both stimuli proves effective at increasing TGF‐β signaling, which promotes the expression of tendon‐associated genes and corresponding protein synthesis, suggesting that microstructural cues and biomolecule sequestration act in tandem to direct cell fate commitment. Overall, this system recapitulates several elements of tendon development, constituting a promising strategy for the regeneration of this tissue. [ABSTRACT FROM AUTHOR]

Background: By combining high-frequency and contrast-enhanced ultrasound (CEUS), the position of the severed end of a finger extensor tendon injury and the injury classification can be determined as part of a comprehensive preoperative evaluation in clinical practice. However, there have been no reports of high-frequency ultrasound combined with CEUS for the preoperative diagnosis of human finger extensor tendon injury. Cases presentation: One case of complete rupture of the extensor tendon was diagnosed by ultrasound, which was completely consistent with the surgery; one case of incomplete rupture was ultimately confirmed clinically; and one case of distal phalangeal bone base avulsion fracture with tendon contusion and missed diagnosis on the first radiographic examination was confirmed by follow-up radiographic examination. Conclusions: Different types of finger extensor tendon injuries exhibit distinctive contrast-enhanced ultrasonography findings. Combined high-frequency and contrast-enhanced ultrasound can accurately locate the position of the severed end of the finger extensor tendon injury before surgery while observing the contrast agent filling area to clarify injury classification, providing a reliable imaging basis for clinical practice and ultimately developing personalized diagnosis and treatment plans for patients to ensure minimal trauma and pain, as well as optimal treatment effects. [ABSTRACT FROM AUTHOR]

Tendon injuries are common orthopedic ailments with a challenging healing trajectory, especially in cases like the Achilles tendon afflictions. The healing trajectory of tendon injuries is often suboptimal, leading to scar formation and functional impairment due to the inherent low metabolic activity and vascularization of tendon tissue. As pressing is needed for effective interventions, efforts are made to explore biomaterials to augment tendon healing. However, tissue engineering approaches face hurdles in optimizing tissue scaffolds and nanomedical strategies. To navigate these challenges, an injectable hydrogel amalgamated with human umbilical vein endothelial cells-derived exosomes (HUVECs-Exos) was prepared and named H-Exos-gel in this study, aiming to enhance tendon repair. In our research involving a model of Achilles tendon injuries in 60 rats, we investigated the efficacy of H-Exos-gel through histological assessments performed at 2 and 4 weeks and behavioral assessments conducted at the 4-week mark revealed its ability to enhance the Achilles tendon's mechanical strength, regulate inflammation and facilitate tendon regeneration and functional recovery. Mechanically, the H-Exos-gel modulated the cellular behaviors of macrophages and tendon-derived stem cells (TDSCs) by inhibiting inflammation-related pathways and promoting proliferation-related pathways. Our findings delineate that the H-Exos-gel epitomizes a viable bioactive medium for tendon healing, heralding a promising avenue for the clinical amelioration of tendon injuries. [ABSTRACT FROM AUTHOR]

Both acute and chronic tendon injuries are the most frequently occurring musculoskeletal diseases in human and veterinary medicine, with a limited repertoire of successful and evidenced-based therapeutic strategies. Inflammation has been suggested as a key driver for the formation of scar and adhesion tissue following tendon acute injury, as well as pathological alternations of degenerative tendinopathy. However, prior efforts to completely block this inflammatory process have yet to be largely successful. Recent investigations have indicated that a more precise targeted approach for modulating inflammation is critical to improve outcomes. The nuclear factor-kappaB (NF-κB) is a typical proinflammatory signal transduction pathway identified as a key factor leading to tendon disorders. Therefore, a comprehensive understanding of the mechanism or regulation of NF-κB in tendon disorders will aid in developing targeted therapeutic strategies for human and veterinary tendon disorders. In this review, we discuss what is currently known about molecular components and structures of basal NF-κB proteins and two activation pathways: the canonical activation pathway and the non-canonical activation pathway. Furthermore, we summarize the underlying mechanisms of the NF-κB signaling pathway in fibrosis and adhesion after acute tendon injury, as well as pathological changes of degenerative tendinopathy in all species and highlight the effect of targeting this signaling pathway in tendon disorders. However, to gain a comprehensive understanding of its mechanisms underlying tendon disorders, further investigations are required. In the future, extensive scientific examinations are warranted to full characterize the NF-κB, the exact mechanisms of action, and translate findings into clinical human and veterinary practice. [ABSTRACT FROM AUTHOR]

Tendinous and ligamentous injuries are common in sport horses, as these structures have a complex organization and are dependent on the integrity of the extracellular matrix to perform their proper function. Although these injuries have the ability to heal over time, the scarring process results in the formation of tissue with inferior biomechanical properties, leading to an increased likelihood of injury recurrence. The main objective of therapy for horses with ligament and tendon injuries is to restore their previous performance capacity and prevent reinjury. This objective is supported by regenerative medicine, which aims to restore the optimal structure and function of the affected tissues (Ortved Kyla, 2018). Currently, the primary orthobiological options used in the treatment of tendinous conditions in horses are stem cells and platelet-rich plasma (PRP). In cases where conventional treatment methods have not been successful, these therapies, combined with a gradual and monitored rehabilitation program, have shown increased efficacy and are considered among the most promising therapeutic solutions available. The aim of this paper is to provide a synthesis of current knowledge regarding the use of stem cells and PRP in the treatment of tendinous conditions in horses. The study includes both basic information on stem cells and PRP, as well as details on how these therapies are applied. Furthermore, the paper presents an analysis of the results of 33 studies that have investigated the use of these biological preparations in the therapy of tendon and ligament injuries in horses, highlighting the therapeutic potential of mesenchymal stem cells and PRP in the complete recovery of affected animals. [ABSTRACT FROM AUTHOR]

Case: We present a unique case of a 45-year-old man with his right middle finger embedded with rings. Limited finger flexion was noted because of flexor tendon injury caused by the dorsal migration of the embedded ring through joint. The rings were removed under anesthesia, resulting in the resolution of swelling and recover of osseous structure. Follow-up examinations revealed no residual edema or numbness, indicating preserved neurovascularization, despite the dorsalmigration of the ring. Conclusion: Our unique case reveals continuous finger ring migration without compromising neurovascular bundles, with review of 30 cases emphasizing the importance of psychiatric consultation. Timely intervention yielded nearly half of patients achieving full recovery. [ABSTRACT FROM AUTHOR]

The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Background: To the best of our knowledge, no studies have attempted to correlate athletic performance with muscle injuries sustained during Paralympic Games. Aim: This study reports the incidence, anatomical location, anatomical site classification, and relationship between competition results and anatomical site classification in athletes who participated in the Paralympic Games. Methods: All magnetic resonance images collected at the International Paralympic Committee polyclinic at the Tokyo 2020 Paralympic Games were reviewed to identify the presence and anatomical site of muscle injuries. The athletes' competition results were reviewed using IPC data sources. Results: Twenty-six magnetic resonance imaging–detected muscle injuries were observed in 16 male and 10 female athletes. Muscle injuries were most commonly observed during track and field events (n = 20) and in athletes with visual impairment (n = 12). Ten of the injuries involved the tendon. Twenty-one of injured athletes (81%) completed their competition, whereas five athletes did not. Eight athletes won medals in the games. The anatomical site of muscle injury did not significantly impact the proportion of athletes who did not finish competition. Conclusions: Many athletes who sustained muscle injuries completed their competitions. No association was found between anatomical site classification and Paralympic athletes' performance in this study. [ABSTRACT FROM AUTHOR]

This article presents a case study on the treatment of a complete extensor tendon rupture in a patient with rheumatoid arthritis. The patient, a 73-year-old woman, experienced a rupture of all extensor tendons in her fingers. The authors performed a surgical procedure involving tendon transfer and tenodesis to restore finger extension. The patient showed positive results in finger range of motion after six months. This case study suggests that this treatment option may be suitable for patients with complete extensor rupture and thumb joint deformity, as long as wrist range of motion is normal. [Extracted from the article]